Differentiating Generalized Epilepsy vs Focal Epilepsy with Secondary Bilateral Synchrony in Newly Diagnosed Patients
Abstract number :
2.092
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2021
Submission ID :
1825706
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Manisha Holmes, MD - NYU Langone; aaron smith, BS - NYU Langone; Dennis Dlugos, MD - CHOP; Michael Gelfand, MD, PhD - Penn; tricia Ting, MD - MedStar; Orrin Devinsky, MD - NYU; Jacqueline French, MD - NYU
Rationale: The Human Epilepsy Project 3 (HEP3) is a currently enrolling, multicenter, prospective, observational study whose primary goal is to identify clinical characteristics and biomarkers predictive of disease outcome, progression, and treatment response in participants with recently diagnosed idiopathic generalized epilepsy (IGE). An initial step requires establishing which patients meet diagnostic criteria for IGE. The primary objective of this study was to explore agreement and confidence in diagnosis of IGE among expert epileptologists.
Methods: HEP3 inclusion criteria include initiation of anti-seizure medication within 12 months of enrollment, EEG demonstrating generalized spike/wave of >3 Hz, and history consistent with GTCSs, myoclonus, and/or absence. Participants without generalized spike/wave of >3 Hz, but with history of GTCSs associated and absence and/or myoclonus can also be enrolled. Site principal investigators identified study candidates and submitted standardized deidentified data, including seizure semiology, clinical history, and images of pertinent EEG findings, for adjudication. An adjudication committee composed of five expert epileptologists reviewed eligibility forms and independently scored participants as “accept with > 80% confidence of IGE diagnosis,” “accept with 50-80% confidence,” or “reject.” They were asked to comment on what features, seizure types, EEG, or other clinical features, led to < 80% confidence.
Results: Thus far the study sample includes N=30 participants. 0 participants were rejected, 21 met > 80% confidence of a diagnosis of IGE (11 with 100% agreement) and 9 met 50-80% confidence (1 with 100% agreement). When reasons for scoring as < 80% were given, in 14 participants the reason was EEG, in 5 seizure semiology, and in 2 age of seizure onset. 20% of patients ultimately included in the study did have at least 1 vote for < 50% confidence. Two participants ended up with a consensus of >80% though they had at least one vote for < 50%.
Conclusions: Critical review of semiology, clinical history, and EEG by expert epileptologists leaves some diagnostic uncertainty in newly diagnosed patients with reported IGE. In HEP3 patients will be followed prospectively and diagnosis will be verified over time.
Funding: Please list any funding that was received in support of this abstract.: FACES (Finding a Cure for Epilepsy and Seizures), One8 Foundation, and Greenwich Biosciences.
Clinical Epilepsy